Facial Blushing Treatment

Description:
Another manifestation of hyper-sympathetic activity is seen with patients whose faces develop reddish discoloration in certain heightened social or emotional situations. The fact that this is seen in many patients with palmar hyperhidrosis (hand sweating) led clinicians to suggest that facial blushing alone was also a result of hyper-sympathetic activity. Facial blushing is noted to affect young patients especially in their teens and early twenties. It should be separated from those instances when subjects have red discoloration on a steady basis. There are some skin disorders such as rosacea that should be mixed with the entity of facial blushing.

Treatment Options:
It was noted that in a significant number of cases there was an association between palmar hyperhidrosis and facial blushing in certain social situations. It was also noted that when ETS was done to treat palmar hyperhidrosis there was an initial improvement with facial blushing. It led to the assumption that doing sympathectomy for isolated cases with facial blushing would also help. Early reports which were published about this led to the thought that ETS could help with solving this socially and functionally embarrassing problem. Unfortunately those reports were pre-mature and the initial enthusiasm about this solution faded. At present those surgeons who are leaders in the field of endoscopic thoracic sympathectomy are not recommending ETS for facial blushing. The reason for this recommendation is a high failure rate when ETS is done for facial blushing and also the association of very high incidence of unwanted side effects.

Summary:
In contrast to views that were held in the past it is now not recommended to treat facial blushing with surgical intervention such as ETS. A patient should exhaust all other options such as medications, bio-feedback, behavior modification etc in an attempt to help this condition.

The response for your question is a personal one. I have learned over the last two decades that blushing is not a good indication for performing the ETS procedure. In the mid nineties ETS surgeons, including myself had some clinical data that blushing can be improved with ETS but as far as I was concerned this thought did not mature. Considering myself as a good surgeon, with good a conscience, I saw that the percentage of improving was not worth the added percentage of side effects. Having observed these clinical results, I decided not to perform ETS for facial blushing. This was my personal decision. I know that there are some surgeons who are performing for this indication but I do not concur with them. I believe that the facial blushing is a combination of some excessive hypersympathetic activity and other basic physiological factors for which we do not have an answer. I follow a lot of patients over the years that had ETS done by other surgeons for facial blushing and pretty much most of them are unhappy with the results. So to sum it up I would not recommend ETS for facial blushing.